All posts tagged: cannabinoids

Resolution of cannabinoid hyperemesis syndrome with benzodiazepines- a case series

In summary

A recent series of case studies has revealed the possible benefits of utilizing benzodiazepines to treat cannabinoid hyperemesis syndrome. Cannabis hyperemesis syndrome (CHS) is characterized by nausea, cyclic vomiting, and intense abdominal pain due to chronic cannabis consumption. Although CHS is now gaining recognition for how under-recognized the condition is, many patients suffering from CHS still suffer for long periods of time and have difficulty responding to traditional anti-emetics. Benzodiazepines, a common sleeping medication, were distributed to the four featured patients and appeared to provide rapid relief. Further research should focus on the development of a benzodiazepine-like substance that provides the same antiemetic effects while minimizing side effects.

Benzodiazepines and benzodiazepine-like medications, such as Ambien (zolpidem tartrate), are known to have unsavory side-effects that can negate its benefits. Ambien specifically has been featured heavily in popular media due to the dangerous activities of patients utilizing Ambien for insomnia as some have caused serious accidents and even attempted murder. Considering the dangerous side-effects of such medications, those who report cannabis use or are screened and found to test positive for cannabis use should be advised to immediately cease all cannabis use and general anti-emetics should be attempted before benzodiazepines.

Researchers have attempted to elucidate the relationship between nicotine and cannabis revealing a possible benefit for sensory and cognitive processes. A cannabinoid receptor 1 (CB1) agonist, nabilone, and nicotine were compared against each other and combined and compared with a placebo, resulting in the region and deviant-dependent effects. Temporal regions of the brain were not affected by coadministration of nabilone and nicotine, while frontal regions showed improved cognitive function. Future research should continue to develop therapies that combine CB1 agonist while minimizing the need for nicotine in order to develop therapies for the dysregulation of sensory and cognitive processes.

So little is still understood about the interactions of the endocannabinoid system, nicotinic receptors, and the opioid system. If the mechanisms underlying these various systems were well understood perhaps novel therapies could be developed to aid in the treatment of substance abuse disorders. Cannabis poses much less risk for addiction than opioids or nicotine as cannabis does not enact upon the reward system. Cannabis holds promise to lessen the troubles associated with the opioid academic by treating current addicts and preventing future addiction by serving as an adjunct therapy. Further research is needed to validate these hypotheses, but the current data provides hope for more ethical treatment methods.

Effects of cannabinoid administration for pain- A meta-analysis and meta-regression

In Summary

A recent meta-analysis provided further evidence that cannabis can be used as a replacement and adjunctive therapy option for opioids. Across all of the studies, it was found that cannabis had a medium-to-large effect on the subjective pain felt. The included studies included a range of given doses, all reported in milligrams and were conducted in various pain models, including Human Immunodeficiency Virus, Cancer, Neuropathic Pain, Diabetes, and more. Further research is needed to standardize an appropriate dose for each condition and ensure the validity of such medications.

The authors take care to emphasize the need for alternative pain therapies for opioids that are safer and more economically responsible. Currently, pain-related costs from patients, caretakers, and healthcare facilities continue to grow beyond $600-billion annually, as more people grow dependent on opioids. Cannabis is much more cost-effective, and even if it does not entirely replace opioid therapies and is simply an adjunct therapy, it has the potential to greatly reduce the amount of opioid prescribed and lower the necessary dose. Opioids are highly addictive whereas cannabis has a much better safety profile, yet cannabis is still deemed medically irrelevant by the federal government. More research needs to be conducted to reduce the chance of addiction, the opioid crisis in general, and reduce the economic burden of pain-related costs in the United States.

Researchers have recently found a cannabinoid-like compound, VSN16R, which is able to modulate Ca2+– activated potassium channels and may reduce seizure severity. By hyperpolarizing the neurons through the opening of Ca2+– activated potassium channels VSN16R ultimately results in the reduction of hyperexcitability seen in individuals who suffer from seizures. The compiled data reveals that cannabinoids or compounds structurally similar to cannabinoids may prove useful in the treatment of seizures or epileptic disorders, similar to the cannabinol-based Epidiolex® medication for rare forms of epilepsy, reducing the chance of a seizure or minimizing its duration. Further research is needed to aid the development of more readily available cannabis-based therapies for seizure activity and more general forms of epilepsy.

Highlighting in this article are the options for treatment that the endocannabinoid system provides us, even in the absence of naturally occurring cannabinoids. If structurally similar compounds like VSN16R are able to be synthesized and proven effective, it could mean novel therapies could be developed even while red tape surrounds cannabis. The endocannabinoid system affects a myriad of systems within the human body and is severely under-researched considering its potential. Epidiolex® is the only cannabinoid-based medication currently approved by the federal government but cannabis has shown promise in so many other areas where the current treatment is either ineffective or lacking. Research utilizing the endocannabinoid system as a target should continue and be pushed to the forefront of the medical community.

An overview of the synthetic and medicinal perspectives of indenopyrazoles

In Summary:

Indenopyrazoles, molecules crucial to many biological signaling pathways, have been found to bind to cannabinoid receptors and seem to exhibit therapeutic properties in a variety of conditions. A review of studies on the molecule describes previously documented antimycobacterial, antipsychotic, anti-tumor, and anti-microbial properties, among others. The molecule has demonstrated moderate affinity for both cannabinoid-1 and cannabinoid-2 receptors, suggesting possible additional anti-inflammatory and anti-neurodegenerative capabilities related to the interactions with these receptors. Further research may uncover additional therapeutic applications and shed light on additional benefits of cannabinoid receptors.

A recent study has revealed that the co-activation of mu-opioid receptors and cannabinoid receptor 1 (CB1) results in the attenuation of the response seen when each receptor type is activated on its own. The decreased response of the two receptor types during co-activation has been implicated in negatively modulating neuritogenesis (the process of generating new brain nerve cells). Neuritogenesis is important for the cells’ ability to receive and project signals leading the researchers to call for more research in order to elucidate the effect this may have on addiction.

The fact that there is co-interaction between opioid receptors and cannabinoid receptors is also interesting to inform the discussion of the place that cannabinoid actors may have in supporting the healing of those who are dependent or addicted to opiate medications.

As with all elements of the aging process, the human endocannabinoid system loses tone over time. Whether it is a reduction in the numbers of cannabinoid receptors or a slow waning of the machinery used to create the signaling molecules that bind to the receptors or the natural senescence of the system that supports all of these normal signaling processes, the fact remains that adults over 50 are best-suited for external support for the endocannabinoid system.

Indeed, the average age at dispensaries is surprising to most who are not familiar with the modern medical cannabis arena. Baby Boomers, perhaps more than any other age group, tend to dominate the medical cannabis dispensaries. This is no new phenomenon, however. Through the ages, across cultures and around the globe, cannabis has been consumed primarily by older adults. Whether by tribe elders, wise councilmen, spiritual leaders, or the educated elite, cannabis has been an integral part of human aging for as long as we have recorded history.

Here, a review out of Israel followed at 184 patients over 65 (average age was 81.2) beginning cannabis treatment. 63.6% were female. “After six months of treatment, 58.1% were still using cannabis. Of these patients, 33.6% reported adverse events, the most common of which were dizziness (12.1%) and sleepiness and fatigue (11.2%). Of the respondents, 84.8% reported some degree of improvement in their general condition.”

Appropriately, the authors advise caution for older adults related to those adults who may be consuming multiple pharmaceuticals, for potential medication interaction effects, as well as nervous system impairment, and increased cardiovascular risk for those who may quire the concern. Wisely, they recommend that “Medical cannabis should still be considered carefully and individually for each patient after a risk-benefit analysis and followed by frequent monitoring for efficacy and adverse events.”

Dr. Caplan and the #MDTake:

At CED Clinic, we have long seen that the average age of medical patients is over 50. Whether for concerns related to sleep, pain, mental or physical health, it seems as though Baby Boomers have either weathered enough politics to have developed a healthy cynicism for the misinformation campaigns of the 1930s and 1970s, or they have direct or indirect experience with cannabis to have learned of its safety and efficacy. Either way, it is quickly reclaiming its historical place in the care of older adults, although oddly… it seems to be a demographic skipped over by the marketing systems of most establishments in the cannabis arena, at least for now.

There are many headache and migraine medications on the market that advertise how they can make you feel better. But what happens when they make you feel worse? Medication overuse headaches occur in 15% of patients taking conventional migraine medication, so it’s no surprise that people are looking for alternatives that bring them relief without reduced risk.

A team of physicians from Washington University wanted to see if cannabis could be a contender. By reviewing data from about 2,000 patients who logged the details of their smoking sessions with the app StrainPrint, researchers were able to see if inhaling cannabis Flower or concentrate could be a solution for headache and migraine relief. They learned that there was, in fact, good reason to be hopeful for the herb.

While concentrates did have a larger reduction in severity rating, there haven’t been enough studies to say it is certainly better than Flower. Overall, inhaled cannabis reduced the severity of migraines and headaches by 50%. Some patients did report needing to use a larger dose for future sessions, indicating the development of tolerance, but the severity of the headaches or migraines wasn’t getting worse or more frequent like what can happen with conventional medications.

In a time when plant-based and all-natural medicines are becoming more sought out, it’s exciting to see medical cannabis is being considered more seriously as a contender. With the positive results from this study, and similar related work will hopefully encourage more physicians (and patients) to explore this centuries-old option.

Recommendations for the medical management of chronic venous disease- The role of Micronized Purified Flavonoid Fraction (MPFF)

In Summary:

A recent review has affirmed that treating chronic venous disease with Micronized Purified Flavonoid Fraction (MPFF) therapy is safe and effective. After reviewing 250 papers, the authors have found a large body of supportive evidence that the MPFF treatment, known as Diosmiplex, is effective for healing venous ulcers on its own or in combination with compression therapy. Diosmiplex, the only MPFF prescribed in the United States, as of 2017, is derived from orange rinds and favorable among patients due to its high safety rating.

Dr. Caplan and the #MDTake:

Flavonoids are one of the categories of natural compounds produced in nature, including within the innate production system of the cannabis plant. Several patients have reported using strong cannabis topical agents to help venous insufficiency and disease, including conditions such as varicose veins, phlebitis, and post-surgical venous incompetence.

Earlier this June, a review was published that encourages oncologists to recommend cannabis products to their patients as a safe and effective method of palliative care. The opinion piece highlights how cannabis is a useful treatment for a variety of illnesses (nausea, vomiting, sleep, mood, anxiety), and encourages practitioners to prescribe cannabis for their patients so that they can appreciate the safety and effectiveness of the product.